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. 2025 May;13(3):102198.
doi: 10.1016/j.jvsv.2025.102198. Epub 2025 Jan 29.

Promising results of ultrasound guided foam sclerotherapy for treating chronic venous ulcers

Ana Clarice de Carvalho Bacelar  1 , Eduardo M Netto  2 , Natália Barreto  3 , Rodrigo Neves  3 , Cláudia Heine  3 , Pedro Botelho  3 , Clarissa S Almeida  4 , Eduardo Ramalho  3 , Roque Aras  5
Affiliations

Promising results of ultrasound guided foam sclerotherapy for treating chronic venous ulcers

Ana Clarice de Carvalho Bacelar et al. J Vasc Surg Venous Lymphat Disord. 2025 May.

Abstract

Background: Despite advances in wound care, the dressing and management of chronic ulcers on lower limbs remains unsatisfactory. The simplicity, cost effectiveness, and diverse application possibilities of ultrasound-guided foam sclerotherapy make it an attractive and effective approach to treat patients with no access to or contraindications to more invasive methods. We sought to evaluate the healing rate of chronic venous ulcers (Clinical, Etiological, Anatomical, Pathophysiological [CEAP] C6) in patients treated with ultrasound guided foam sclerotherapy.

Methods: From January 2018 to December 2020, 279 patients (336 legs) classified at the first consultation as stage 6 for CEAP disease were followed during treatment of axial venous reflux in saphenous and tributary veins with polidocanol (Aethosxysklerol) foam and evaluated at 52 weeks for complete healing rates or ≥50% ulcer size reduction, using Kaplan-Meier statistics and Cox regression to study the influence of covariates.

Results: The average age of the 279 patients was 55 years. Of these, 156 (56%) showed complete healing in 52 weeks and 89 (32%) achieved a wound area reduction of >50%. Ulcer size, severity, lymphedema, and reduced dorsiflexion of the ankle were significantly associated with healing difficulty. Time of ulcer progression up to beginning of treatment (P < .01), ulcer size (P = .01), lymphedema (P = .006), reduced dorsiflexion of the ankle (P = .01), and age ≥65 years (P = .003) were significantly associated with difficulty in healing. Patients with a mean Venous Clinical Severity Score of 18.7 had a better prognosis (18.7 vs 22.5; P < .001).

Conclusions: Most patients with chronic venous ulcers (CEAP 6) treated with foam sclerotherapy achieved healing or significant improvement within 52 weeks. Healing was highly influenced by time until treatment, ulcer size, reduced dorsiflexion of the ankle and/or lymphedema presence, and the use of compression therapy.

Keywords: Doppler; Foam; Sclerotherapy; Ulcer; Ultrasound; Varicose ulcer; Venous hypertension.

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Conflict of interest statement

Disclosures None.

Figures

Fig 1
Fig 1
Flow diagram of patients with venous leg ulcers (VLUs). CEAP, Clinical, Etiological, Anatomical, Pathophysiological.
Fig 2
Fig 2
Ulcer healing rates (cured and more than 50% healed). ∗At week 52, 31.9% of patients with ≥50% ulcer healing were classified as treatment partial success.
Fig 3
Fig 3
Ulcer healing history >6 months.
Fig 4
Fig 4
Cumulative ulcer complete healing up to 52 weeks of follow-up by age strata.
See this image and copyright information in PMC

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